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  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #1103
    Tuesday, January 21, 2020
    General Description: Nurse Navigators (NNs) employed by Health Partners Plans (HPP) via funding from the DHS Amendment/Community Based Care Management (CBCM) Program work between practice site care teams including Community Health Workers (CHWs), Community Behavioral Health (CBH) staff and HPP. It is the responsibility of NNs employed via this pilot program to monitor progress and information sharing regarding the Top 10% of HPP members who are eligible for this program. A key part of this wor ... More
  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #1102
    Thursday, January 16, 2020
    Working with the supervisor of marketing communications and the editorial team, the marketing communications specialist will assist in implementing annual and long-range communications strategies to include all aspects of external communications, including newsletter and communication materials, sales and member information, provider communication materials, advertising, social media and event planning and promotion. The communications specialist will also assist in researching and drafting copy ... More
  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #1074
    Monday, December 30, 2019
    Summary/Objective:   Lead and direct, across multiple service or business units, the Provider Network team to meet or exceed service requirements and business objectives in multiple lines of business and geographic territories.  Those territories include the entire Commonwealth of Pennsylvania as well as adjacent states.  Primary responsibility is to strategically plan, grow and contract with a comprehensive, quality, high performing, culturally appropriate (language and ethnicity) marketable ... More
  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #1094
    Monday, December 16, 2019
    Chief Financial Officer   Date:   November 12, 2019                                        Grade:            UNG   Department:  Executive                                           FLSA:            Exempt   Reports To:  President and CEO                              Job Code:       3362                           Written By:    President and CEO                            Approved By: Human Resources   General Descrip ... More
  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #974
    Thursday, February 21, 2019
    General Description: Respond to participating providers’ incoming calls, and take appropriate action to resolve providers’ issues.  Educate callers about the plan and retain providers using effective customer service techniques to provide a high level of service. Dual role supporting incoming calls from both member’s and providers Primary Responsibilities: Provide accurate and complete information in response to providers’ inquiries, complaints and/or problems.  Collaborate with internal departm ... More
  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #885
    Tuesday, September 25, 2018
    Position Summary Responsible for the resolution of provider claim reconsideration requests, member billing complaints and related issues involving claim adjustment processing via correspondence, portal requests or projects submitted by providers. Responsibilities Handle and resolve claim inquiries, complaints and appeals received from providers.Adjudicate claim adjustments on line while servicing the provider.Resolve all assigned claim reconsideration requests through MACESS, including completin ... More
  • Philadelphia, 901 Market Street, Philadelphia, PA, USA
    Req #677
    Thursday, November 16, 2017
     Position Summary: Working under general supervision responsible for the resolution of provider claim reconsideration requests, member billing complaints and related issues involving claim adjustment processing via correspondence and/or by telephone.Qualifications:Minimum of three years of claim processing, medical billing, or medical coding experience.Minimum of one year customer service experience.Excellent communication skills; with the ability to write a comprehensive letter of particular im ... More